Primary aldosteronism: functional histopathology and long‐term follow‐up after unilateral adrenalectomy. (19th December 2014)

• Record Type: Journal Article
• Authors: Volpe, Cristina; Hamberger, Bertil; Höög, Anders; Mukai, Kuniaki; Calissendorff, Jan; Wahrenberg, Hans; Zedenius, Jan; Thorén, Marja
• Is Part Of: Clinical endocrinology. Volume 82:Number 5(2015:May)
• Page Start: 639
• Page End: 647
• Publication Date: 2014-12-19
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.12645
• Languages: English
• ISSNs: 0300-0664

Abstract

<abstract abstract-type="main" id="cen12645-abs-0001"> <title>Summary</title> <sec id="cen12645-sec-0001" sec-type="section"> <title>Objectives</title> <p>To investigate the long‐term outcome after unilateral adrenalectomy in patients with primary aldosteronism (PA) and to establish the role of functional pathology for the final diagnosis of aldosterone‐producing adenoma (APA) or hyperplasia.</p> </sec> <sec id="cen12645-sec-0002" sec-type="section"> <title>Design</title> <p>A single‐centre, retrospective cohort study in a hospital setting.</p> </sec> <sec id="cen12645-sec-0003" sec-type="section"> <title>Patients</title> <p>Consecutive patients with PA, <italic> n</italic> = 120, who underwent unilateral adrenalectomy between 1985 and 2010. Preoperative and postoperative data were analysed. To indicate the site of aldosterone secretion in the resected adrenal, we added functional methods to routine histopathology, using <italic>in situ</italic> hybridization and immunohistochemistry to detect the presence of enzymes needed for aldosterone (CYP11B2) and cortisol (CYP11B1, CYP17A1) synthesis.</p> </sec> <sec id="cen12645-sec-0004" sec-type="section"> <title>Results</title> <p>The median follow‐up was 5 years and the cure rate of PA 91%. Hypertension was improved in 97% and normalized in 38%. Functional histopathology changed the final diagnosis from APA to hyperplasia in 6 cases (7%). Five of these had no expression of or staining for aldosterone synthase in the adenoma, but only in nodules in the adjacent cortex. All except one APA patient were cured of PA. They had lower preoperative serum potassium and higher 24‐h urinary aldosterone than patients with hyperplasia. Among patients with hyperplasia 16 of 26 were cured.</p> </sec> <sec id="cen12645-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Most patients were cured of PA by unilateral adrenalectomy. Almost all noncured benefitted from the operation as the blood pressure improved. Functional histopathology proved helpful in the distinction between APA and hyperplasia, and we recommend that functional histopathology should be added to routine histopathology to improve the diagnostic evaluation and aid in tailoring the follow‐up.</p> </sec> </abstract>